1. health and fitness
2. disease

UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
Cefalexin 250 mg Capsules
Cefalexin 500 mg Capsules
(cefalexin)
PL 35507/0104-5
UK Public Assessment Report
TABLE OF CONTENTS
Lay Summary
Page 2
Scientific discussion
Page 3
Steps taken for assessment
Page 14
Steps taken after authorisation
Page 15
Summary of Product Characteristics
Page 16
Product Information Leaflet
Page 23
Labelling
Page 25
1
UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
Cefalexin 250 mg Capsules
Cefalexin 500 mg Capsules
(cefalexin)
PL 35507/0104-5
LAY SUMMARY
The Medicines and Healthcare products Regulatory Agency (MHRA) granted Lupin
(Europe) Limited Marketing Authorisations (licences) for the medicinal products
Cefalexin 250 mg and 500 mg Capsules (PL 20092/0064-5) on 15th July 2011. These
licences underwent Change of Ownership on 7th September 2011 and are still held by
Lupin (Europe) Limited (PL 35507/0104-5). These are prescription-only medicines
(POM).
Cefalexin 250 mg and 500 mg Capsules contain the active ingredient cefalexin, which
is an antibiotic. Antibiotics work by killing the bacteria (germs) that can cause an
infection.
Cefalexin Capsules are used to treat infections of:
•
the lungs and breathing airways (bronchitis and mild to moderate pneumonia)
•
the skin and soft tissue (such as wound infection)
The test products were considered to be generic versions of the UK reference products
Keflex / Cefalexin 250 mg and 500 mg Capsules (PL 13621/0025 and 0021, Flynn
Pharma Limited) based on the data submitted by Lupin (Europe) Limited.
No new or unexpected safety concerns arose from these applications. It has been
judged that the benefits of Cefalexin 250 mg and 500 mg Capsules outweigh the risks;
hence Marketing Authorisations have been granted.
2
UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
Cefalexin 250 mg Capsules
Cefalexin 500 mg Capsules
(cefalexin)
PL 35507/0104-5
SCIENTIFIC DISCUSSION
TABLE OF CONTENTS
Introduction
Page 4
Pharmaceutical assessment
Page 6
Pre-clinical assessment
Page 9
Clinical assessment
Page 10
Overall conclusion and risk benefit assessment
Page 13
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
INTRODUCTION
Based on the review of the data on quality, safety and efficacy, the MHRA granted
Lupin (Europe) Limited Marketing Authorisations for the medicinal products
Cefalexin 250 mg and 500 mg Capsules (PL 20092/0064-5) on 15th July 2011. These
licences subsequently underwent Change of Ownership on 7th September 2011 and
are still held by Lupin (Europe) Limited (PL 35507/0104-5). These are prescriptiononly medicines (POM).
These are generic applications for Cefalexin 250 mg and 500 mg Capsules, submitted
under Article 10.1 of Directive 2001/83 EC, as amended. The applications refer to the
UK products, Keflex / Cefalexin 250 mg and 500 mg Capsules, originally awarded
default conversion licences to Eli Lilly and Company Limited (PLs 00006/5103 and
0076) in 1985. These licences underwent Change of Ownership (CoA) procedures in
October 2005 and are currently authorised to Flynn Pharma Limited (PL 13621/0025
and 0021). The reference products have been authorised in the UK for more than 10
years, thus the period of data exclusivity has expired.
Cefalexin is a semi-synthetic cephalosporin antibiotic (ATC code – J01D B01) for
oral administration. It is indicated in the treatment of the following infections due to
susceptible micro-organisms:
•
Exacerbation of chronic bronchitis
•
Mild to moderate community-acquired pneumonia
•
Uncomplicated upper and lower urinary tract infections
•
Skin and soft tissue infections
Like other cephalosporins, cefalexin exerts antibacterial activity by binding to and
inhibiting the action of penicillin-binding proteins involved in the synthesis of
bacterial cell walls. This leads to bacterial cell lysis and cell death.
No new pre-clinical or clinical efficacy studies were conducted for these applications,
which is acceptable given that the applications were for generic versions of products
that have been licensed for over 10 years.
The applications are supported by a bioequivalence study comparing the
pharmacokinetic profile of the test product, Cefalexin 500 mg Capsules, to that of the
clinical reference product, Keflex 500 mg Capsules (Flynn Pharma Limited). The
bioequivalence study was carried out in accordance with Good Clinical Practice
(GCP).
The MHRA has been assured that acceptable standards of Good Manufacturing
Practice (GMP) are in place for this product type at all sites responsible for the
manufacture and assembly of these products. Evidence of compliance with GMP has
been provided for the named manufacturing and assembly sites.
The MHRA considers that the pharmacovigilance system as described by the
Marketing Authorisation Holder (MAH) fulfils the requirements and provides
adequate evidence that the MAH has the services of a Qualified Person (QP)
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
responsible for pharmacovigilance and has the necessary means for the notification of
any adverse reaction suspected of occurring either in the Community or in a third
country.
The MAH has provided adequate justification for not submitting a Risk Management
Plan (RMP). As the applications are for generic versions of already authorised
reference products, for which safety concerns requiring additional risk minimisation
have not been identified, routine pharmacovigilance activities are proposed and a risk
minimisation system is not considered necessary. The reference products have been in
use for many years and the safety profile of the active is well-established.
The MAH has provided adequate justification for not submitting a detailed
Environmental Risk Assessment (ERA). These were applications for generic products
and there is no reason to conclude that marketing of these products will change the
overall use pattern of the existing market. There are no environmental concerns
associated with the method of manufacture or formulation of the products.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
PHARMACEUTICAL ASSESSMENT
ACTIVE SUBSTANCE
Cefalexin
Nomenclature:
INN:
Cefalexin monohydrate
Chemical name:
(6R,7R)-7-[[(2R)-2-Amino-2-phenylacetyl]amino]-3-methyl-8oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid
monohydrate
Structure:
Molecular formula:
C16H17N3O4S , H2O
Molecular weight:
365.4 g/mol
CAS No:
23325-78-2
Physical form:
A white or almost white crystalline powder
Solubility:
Sparingly soluble in water, practically insoluble in alcohol
The active substance, cefalexin monohydrate, is the subject of a European
Pharmacopeia (Ph. Eur.) monograph.
Synthesis of the active substance from the designated starting materials has been
adequately described and appropriate in-process controls and intermediate
specifications are applied. Satisfactory specifications are in place for all starting
materials and reagents and these are supported by relevant Certificates of Analysis.
Confirmation has been provided that the raw materials, intermediates and auxiliary
agents used in synthesis of the active are not of animal, biological or genetically
modified origin.
Appropriate specifications have been provided for the active substance. Analytical
methods have been appropriately validated and are satisfactory for ensuring
compliance with the relevant specifications. Batch analysis data are provided and
comply with the proposed specifications. Satisfactory Certificates of Analysis have
been provided for any reference standards used by the active substance manufacturer
during validation studies.
The active substance is stored in appropriate packaging. Specifications and
Certificates of Analysis have been provided for the packaging materials used. The
primary packaging in direct contact with the active substance complies with relevant
Ph. Eur. requirements and satisfies Directive 2002/72/EC (as amended); it is suitable
for contact with foodstuffs.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
Appropriate stability data have been generated for the active substance stored in the
proposed commercial packaging. These data demonstrate the stability of the active
substance and support the 48-month shelf-life period that has been applied.
MEDICINAL PRODUCT
Description and Composition
Cefalexin 250 mg and 500 mg Capsules are presented as hard, gelatin capsules
containing white to yellowish-white granular powder. Each capsule contains 250 mg
or 500 mg of the active ingredient, cefalexin. The 250 mg strength capsules have a
dark green cap, imprinted with ‘250’, and white body. The 500 mg strength capsules
have a dark green cap, imprinted with ‘500’, and light green body. Full descriptions of
the individual capsules may be found by referring to the Summary of Product
Characteristics or patient information leaflet.
Other ingredients consist of pharmaceutical excipients, namely microcrystalline
cellulose, magnesium stearate and water making up the cores; and gelatin, sodium
lauryl sulphate, sunset yellow FCF (E110), quinoline yellow (E104), titanium dioxide
(E171), patent blue V (E131) and black printing ink making up the capsule shells. The
black printing ink is constituted of shellac, propylene glycol, potassium hydroxide and
black iron oxide (E172). Appropriate justification for the inclusion of each excipient
has been provided.
The excipients of the granular cores comply with their respective European
Pharmacopoeia monographs. The hard gelatin capsule shells comply with satisfactory
in-house specifications. Satisfactory Certificates of Analysis have been provided for
all excipients.
The magnesium stearate has been confirmed as being of vegetable origin. The only
excipient used that contains material of animal or human origin is gelatin. Satisfactory
documentation has been provided by the gelatin suppliers stating that the gelatin they
provide complies with the criteria described in the current version of the monograph
‘Products with risk of transmitting agents of animal spongiform encephalopathies’.
None of the excipients are sourced from genetically modified organisms.
There were no novel excipients used.
Pharmaceutical development
Details of the pharmaceutical development of the medicinal products have been
supplied and are satisfactory. The objective was to develop stable, generic, capsule
formulations, bioequivalent to the reference products, Keflex / Cefalexin 250 mg and
500 mg Capsules (PL 13621/0025 and 0021, Flynn Pharma Limited).
Comparative dissolution and impurity data were provided for batches of the test
products and appropriate reference products. The dissolution and impurity profiles
were satisfactory.
Manufacture
A description and flow-chart of the manufacturing method has been provided.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
In-process controls have been provided and are appropriate considering the nature of
the products and the method of manufacture. Process validation studies were
conducted and the results were satisfactory.
Finished product specification
Finished product specifications are provided for both release and shelf-life and are
satisfactory. Acceptance limits have been justified with respect to conventional
pharmaceutical requirements and, where appropriate, safety. Test methods have been
described and have been adequately validated, as appropriate. Satisfactory batch
analysis data are provided and accepted. The data demonstrate that the batches are
compliant with the proposed specifications. Certificates of Analysis have been
provided for any reference standards used.
Container Closure System
Cefalexin 250 mg and 500 mg Capsules are licensed for marketing in
polyvinylchloride (PVC) / polyvinylidene chloride (PVdC) - aluminium foil blister
strips, which are packaged with the Patient Information Leaflet (PIL) into cardboard
outer cartons in pack sizes of 4, 10, 12, 16, 20, 21, 24, 28, 30, 100 or 112 capsules
(250 mg strength) and 8, 10, 12, 14, 15, 16, 20, 21, 28, 30, 40 or 100 capsules
(500 mg strength). The MAH has stated that not all pack sizes may be marketed.
Satisfactory specifications and Certificates of Analysis for all packaging components
used have been provided. All primary product packaging complies with EU
legislation, Directive 2002/72/EC (as amended), and is suitable for contact with
foodstuffs.
Stability
Finished product stability studies have been conducted in accordance with current
guidelines, using product stored in the packaging proposed for marketing. These data
support the applied shelf-life of 24 months, with the storage instructions ‘Store below
30°C. Store in the original package’.
Quality Overall Summary
A satisfactory quality overview is provided and has been prepared by an appropriately
qualified expert. The CV of the expert has been supplied.
Product Information
The approved Summaries of Product Characteristics (SmPCs), Patient Information
Leaflets (PIL) and labelling are satisfactory. Mock-ups of the PIL and labelling have
been provided. The PIL user-testing report has been evaluated and is accepted. The
labelling text fulfils the statutory requirements for Braille.
The MAH has stated that not all licensed pack sizes may be marketed. They have
committed to submitting mock-ups for unmarketed pack sizes to the MHRA for
approval before those packs are commercially marketed.
Conclusion
All pharmaceutical issues have been resolved and the quality grounds for these
applications are considered adequate. There are no objections to approval of Cefalexin
250 mg and 500 mg Capsules from a pharmaceutical point of view.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
PRE-CLINICAL ASSESSMENT
These abridged applications, submitted under Article 10.1 of Directive 2001/83/EC,
as amended, are for Cefalexin 250 mg and 500 mg Capsules, products claiming to be
generic medicinal products of Keflex / Cefalexin 250 mg and 500 mg Capsules (PL
13621/0025 and 0021; Flynn Pharma Limited).
No new pre-clinical data have been supplied with these applications and none are
required for applications of this type. A pre-clinical overview has been written by a
suitably qualified person and is satisfactory. The CV of the expert has been supplied.
The MAH has provided adequate justification for not submitting an Environmental
Risk Assessment (ERA).
There are no objections to approval of these products from a non-clinical point of
view.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
CLINICAL ASSESSMENT
INDICATIONS
Cefalexin 250 mg and 500 mg Capsules are indicated in the treatment of the following
infections due to susceptible micro-organisms:
•
Exacerbation of chronic bronchitis
•
Mild to moderate community-acquired pneumonia
•
Uncomplicated upper and lower urinary tract infections
•
Skin and soft tissue infections
The indications are consistent with those for the UK reference products and are
satisfactory.
POSOLOGY AND METHOD OF ADMINISTRATION
Full details concerning the posology are provided in the SmPCs. The posology is
consistent with that for the UK reference products and is satisfactory.
TOXICOLOGY
The toxicology of cefalexin is well-known. No new data have been submitted and
none are required for applications of this type.
CLINICAL PHARMACOLOGY
Pharmacodynamics
The clinical pharmacology of cefalexin is well-known. With the exception of the
bioequivalence study, no new pharmacodynamic or pharmacokinetic data are supplied
and none are required for these applications.
Pharmacokinetics - Bioequivalence study
The applications are supported by the bioequivalence study comparing the
pharmacokinetic profiles of Cefalexin 500 mg Capsules (test) and Keflex 500 mg
Capsules - Flynn Pharma Limited (reference). The bioequivalence study was of an
appropriate design and was conducted to principles of Good Clinical Practice (GCP).
Certificates of Analysis were provided for the test and reference products.
This was an open-label, randomised, two-treatment, two-way, two-period, single dose
crossover bioequivalence study conducted in 28 healthy adult male human subjects
under fasting conditions. Following an overnight fast, a single dose of the
investigational products was administered orally, with 240 ml of water, to each
subject in each period. A satisfactory washout period of 4 days was maintained
between the two dosing days in each group.
Blood samples were taken pre-dose (0.0) and at specified time points up to 10.0 hours
after administration of test or reference product. Plasma levels of cefalexin were
quantified by a validated HPLC method.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
The primary pharmacokinetic parameters for this study were Cmax, AUC0-t, and
AUC0-∞. Bioequivalence of the test product versus the reference product was
concluded if the 90% Confidence Intervals (CI) fell within the acceptance range, 0.801.25 (80.00%-125.00%), for log-transformed Cmax, AUC0-t, and AUC0-∞.
Biostudy outcome and results:
28 subjects were enrolled in the study; 27 of these completed the study and were
included in the pharmacokinetic evaluation and statistical analysis. The
discontinuation, and non-inclusion in the pharmacokinetic analysis, of 1 subject was
satisfactorily justified.
Safety - A total of 7 adverse events were reported by 5 subjects. There were no deaths
or serious or significant adverse events reported in the study.
The summary of the results of the bioequivalence study are tabulated below:
Pharmacokinetic results for cefalexin for a randomised, two-way, two-period, single-dose crossover
bioequivalence study between the 500 mg strength test and reference products; n=27 healthy subjects,
dosed fasted; t=10 hours; washout period: 4 days.
Cmax
AUC0-t
AUC0-∞
maximum plasma concentration
area under the plasma concentration-time curve from time zero to t hours
area under the plasma concentration-time curve from time zero to infinity
Conclusion on Bioequivalence
The results of the bioequivalence study show that the test and reference products are
bioequivalent under fasting conditions, as the confidence intervals for Cmax, AUC0-t
and AUC0-∞ for cefalexin fall within the acceptance criteria ranges of 80.00-125.00%,
in line with current guidelines.
Satisfactory justification is provided for a bio-waiver for Cefalexin 250 mg Capsules.
As Cefalexin 250 mg and 500 mg Capsules meet the criteria specified in the
“Guideline on the Investigation of Bioequivalence” (CPMP/EWP/QWP/1401/98), the
results and conclusions of the bioequivalence study on the 500 mg strength can be
extrapolated to the 250 mg strength capsules.
EFFICACY
No new data have been submitted and none are required. The reference products are
established and the applications depend upon the ability to demonstrate
bioequivalence. Efficacy is reviewed in the clinical overview. The efficacy of
cefalexin is well-established from its extensive use in clinical practice.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
SAFETY
No new data have been submitted and none are required for applications of this type.
No new or unexpected safety concerns arose from these applications. Safety is
reviewed in the clinical overview. The safety profile of cefalexin is well-known.
PRODUCT INFORMATION:
Summary of Product Characteristics
The approved SmPCs are consistent with those for the UK reference products and are
acceptable.
Patient Information Leaflet
The final PIL is in line with the approved SmPCs and is satisfactory. The PIL usertesting has been evaluated and is accepted.
Labelling
The labelling is satisfactory.
Clinical overview
A satisfactory clinical overview is provided, and has been prepared by an
appropriately qualified expert. The CV of the clinical expert has been supplied.
CONCLUSIONS
Sufficient clinical information has been submitted to support these applications. The
risk-benefit of the products is considered favourable from a clinical perspective.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
OVERALL CONCLUSION AND BENEFIT- RISK ASSESSMENT
QUALITY
The important quality characteristics of Cefalexin 250 mg and 500 mg Capsules are
well-defined and controlled. The specifications and batch analytical results indicate
consistency from batch to batch. There are no outstanding quality issues that would
have a negative impact on the benefit/risk balance.
PRE-CLINICAL
No new pre-clinical data were submitted and none are required for applications of this
type.
CLINICAL
Bioequivalence has been demonstrated between the applicant’s Cefalexin 500 mg
Capsules and the UK reference product, Keflex 500 mg Capsules (Flynn Pharma
Limited).
As the proposed products, Cefalexin 250 mg and 500 mg Capsules, meet the criteria
specified in the “Guideline on the Investigation of Bioequivalence”
(CPMP/EWP/QWP/1401/98), the results and conclusions of the bioequivalence study
on the 500 mg strength were extrapolated to the 250 mg strength capsules, and
omission of further bioequivalence studies on the lower strength can be accepted.
No new or unexpected safety concerns arise from these applications.
PRODUCT LITERATURE
The approved SmPCs are consistent with those for the UK reference products and are
satisfactory.
A mock-up PIL has been provided. The package leaflet is in line with the SmPCs and
is satisfactory. It has been evaluated via a user consultation study in accordance with
the requirements of Articles 59(3) and 61(1) of Directive 2001/83/EC. The results
show that the package leaflet meets the criteria for readability as set out in the
Guideline on the readability of the label and package leaflet of medicinal products for
human use.
The approved labelling artwork complies with statutory requirements. In line with
current legislation, the name of the product in Braille appears on the outer packaging
and sufficient space has been included for a standard UK pharmacy dispensing label.
The MAH has stated that not all licensed pack sizes may be marketed. They have
committed to submitting mock-ups for unmarketed pack sizes to the MHRA for
approval before those packs are marketed.
BENEFIT- RISK ASSESSMENT
The quality of the products is acceptable and no new pre-clinical or clinical safety
concerns have been identified. The bioequivalence study and its conclusions support
the claim that the applicant’s Cefalexin 250 mg and 500 mg Capsules are generic
versions of the reference products, Keflex / Cefalexin 250 mg and 500 mg Capsules
(Flynn Pharma Limited). Extensive clinical experience with cefalexin is considered to
have demonstrated the therapeutic value of the active substance. The benefit: risk ratio
is considered to be positive.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
Cefalexin 250 mg Capsules
Cefalexin 500 mg Capsules
(cefalexin)
PL 35507/0104-5
STEPS TAKEN FOR ASSESSMENT
1
The MHRA received the marketing authorisation applications for PLs
20092/0064-5 on 8th December 2008.
2
Following standard checks and communication with the applicant the MHRA
considered the applications valid on 29th December 2008.
3
Following assessment of the applications the MHRA requested further
information relating to the quality dossier on 11th March 2009, 29th June
2009,7th October 2010 and 4th February 2011; and further information relating to
the clinical dossier on 1st May 2009.
4
The applicant responded to the MHRA’s requests, providing further information
for the quality sections on 16th June 2009, 10th May 2010, 24th November 2010
and 14th February 2011 respectively; and further information for the clinical
sections on 22nd July 2009.
5
The applications were determined on 15th July 2011
6
The MAs 20092/0064-5 (Lupin (Europe) Limited) underwent Change of
Ownership to MAs 35507/0104-5 (Lupin (Europe) Limited) on 7th September
2011.
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UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
Cefalexin 250 mg Capsules
Cefalexin 500 mg Capsules
(cefalexin)
PL 35507/0104-5
STEPS TAKEN AFTER AUTHORISATION
Not applicable
15
UKPAR Cefalexin 250 and 500 mg Capsules
PL 35507/0104-5
SUMMARY OF PRODUCT CHARACTERISTICS
The UK Summary of Product Characteristics (SmPC) for Cefalexin 250 mg and 500
mg Capsules (PL 35507/0104-5) is as follows. Differences between the individual SmPCs
are highlighted:
1
NAME OF THE MEDICINAL PRODUCT
Cefalexin 250 / 500 mg Capsules
2
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each capsule contains Cefalexin monohydrate equivalent to 250 / 500 mg Cefalexin.
Excipients: Sunset yellow (E110), Quinoline yellow (E104) and Patent Blue V (E131).
For a full list of excipients, see section 6.1.
3
PHARMACEUTICAL FORM
Capsule.
Cefalexin 250 mg Capsules are size ‘2’ capsules with dark green cap and white body
imprinted with ‘250’ in black ink on cap, containing white to yellowish-white granular
powder.
Cefalexin 500 mg Capsules are size ‘0’ capsules with dark green cap and light green body
imprinted with ‘500’ in black ink on cap, containing white to yellowish-white granular
powder.
4
CLINICAL PARTICULARS
4.1
Therapeutic indications
Cefalexin is a semi-synthetic cephalosporin antibiotic for oral administration.
Cefalexin is indicated in the treatment of the following infections due to susceptible microorganisms (see also section 4.4 and 5.1):
•
•
•
•
Exacerbation of chronic bronchitis
Mild to moderate community-acquired pneumonia
Uncomplicated upper and lower urinary tract infections
Skin and soft tissue infections
Consideration should be given to official guidance on the appropriate use of antibacterial
agents.
4.2
Posology and method of administration
Cefalexin is administered orally.
Adults: The adult dosage ranges from 1-4g daily in divided doses; most infections will
respond to a dosage of 500mg every 8 hours. For skin and soft tissue infections, streptococcal
pharyngitis, and mild, uncomplicated urinary tract infections, the usual dosage is 250mg every
6 hours or 500 mg every 12 hours.
For more severe infections or those caused by less susceptible organisms, larger doses may be
needed. If daily doses of cefalexin greater than 4g are required, parenteral cephalosporins, in
appropriate doses, should be considered.
Patients with impaired renal function: Reduce dosage if renal function is markedly impaired
(see section 4.4).
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UKPAR Cefalexin 250 and 500 mg Capsules
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Elderly patients:
The recommended dose for adults should be used in elderly patients except those with
impaired renal function.
Children:
The recommended daily dosage for children is 25-50mg/kg body weight divided in 3 doses. In
severe infections the dosage may be doubled.
In the treatment of beta-haemolytic streptococcal infections, a therapeutic dose should be
administered for at least 10 days.
4.3
Contraindications
Hypersensitivity to the cephalosporin group of antibiotics or to any of the excipients.
4.4
Special warnings and precautions for use
Before instituting therapy with cefalexin, every effort should be made to determine whether
the patient has had previous hypersensitivity reactions to the cephalosporins, penicillins, or
other medicinal products. Cefalexin should be given cautiously to penicillin-sensitive patients.
There is some clinical and laboratory evidence of partial cross-allergenicity of the penicillins
and cephalosporins. Patients have had severe reactions (including anaphylaxis) to both
medicinal products.
Pseudomembranous colitis has been reported with virtually all broad-spectrum antibiotics,
including macrolides, semi-synthetic penicillins, and cephalosporins. It is important, therefore,
to consider its diagnosis in patients who develop diarrhoea in association with the use of
antibiotics. Such colitis may range in severity from mild to life-threatening. Mild cases of
pseudomembranous colitis usually respond to drug discontinuance alone. In moderate to
severe cases, appropriate measures should be taken.
If an allergic reaction to cefalexin occurs, the drug should be discontinued and the patient
treated with the appropriate agents.
Prolonged use of cefalexin may result in the overgrowth of non-susceptible organisms.
Careful observation of the patient is essential. If superinfection occurs during therapy,
appropriate measures should be taken.
Cefalexin should not be used in infections in which Haemophilus influenzae is, or is likely to
be, implicated.
Cefalexin should be administered with caution in the presence of markedly impaired renal
function. Careful clinical and laboratory studies should be made because safe dosage may be
lower than that usually recommended. If dialysis is required for renal failure, the daily dose of
cefalexin should not exceed 500mg.
Positive direct Coombs' tests have been reported during treatment with the cephalosporin
antibiotics. In haematological studies, or in transfusion cross-matching procedures when
antiglobulin tests are performed on the minor side, or in Coombs' testing of newborns whose
mothers have received cephalosporin antibiotics before parturition, it should be recognised
that a positive Coombs' test may be due to the drug.
A false positive reaction for glucose in the urine may occur with Benedict's or Fehling's
solutions, or with copper sulphate test tablets.
Cefalexin capsules contain colouring agents, sunset yellow (E110), quinoline yellow (E104)
and patent blue V (E131) which may cause allergic reactions.
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UKPAR Cefalexin 250 and 500 mg Capsules
4.5
PL 35507/0104-5
Interaction with other medicinal products and other forms of interaction
As with other beta-lactam drugs, renal excretion of cefalexin is inhibited by probenecid.
Concurrent administration with certain other drug substances, such as aminoglycosides, other
cephalosporins, or furosemide, and similar potent diuretics, may increase the risk of
nephrotoxicity.
In a single study of 12 healthy subjects given single 500mg doses of cefalexin and metformin,
plasma metformin Cmax and AUC increased by an average of 34% and 24%, respectively, and
metformin renal clearance decreased by an average of 14%. No side-effects were reported in
the 12 healthy subjects in this study. No information is available about the interaction of
cefalexin and metformin following multiple dose administration. The clinical significance of
this study is unclear, particularly as no cases of “lactic acidosis” have been reported in
association with concomitant metformin and cefalexin treatment.
4.6
Pregnancy and lactation
Pregnancy: There are no adequate and well controlled studies in pregnant women. Although
animal studies have shown no evidence of teratogenicity, caution should be exercised when
prescribing cefalexin during pregnancy (see section 5.3)
Lactation: Cefalexin is excreted in human milk. Caution should be exercised when cefalexin
is administered to a nursing woman.
4.7
Effects on ability to drive and use machines
There are no known effects of cephalexin on a patient’s ability to drive or use machinery.
However, when driving vehicles or operating machines it should be taken into account that
occasionally dizziness or confusion may occur.
4.8
Undesirable effects
Adverse events that have been reported in cefalexin trials are categorised below, according to
system organ class and frequency.
Frequencies are defined as :
Very common ( 1/10);
common ( 1/100,<1/10);
uncommon ( 1/1,000, <1/100);
rare ( 1/10,000, <1/1,000);
very rare (<1/10,000),
not known (cannot be estimated from the available data)
Undesirable effects for cefalexin occur at a frequency of 3-6%.
Investigations:
Uncommon: Increase in ASAT and ALAT (reversible)
Frequency not known: Positive direct Coombs test. False positive reaction to glucose in the
urine
Blood and lymphatic system disorders:
Uncommon: Eosinophilia
Rare: neutropenia, thrombocytopenia,haemolytic anaemia
Nervous system disorders:
Rare: Dizziness, headache
Gastrointestinal disorders:
Common: Diarrhoea, nausea
Rare: Abdominal pain, vomiting, dyspepsia, pseudomembranous colitis.
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Renal and urinary disorders:
Rare: Reversible interstitial nephritis
Skin and subcutaneous tissue disorders:
Uncommon: Rash, urticaria, pruritus
Rare: Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis (Lyell’s
syndrome), anaphylaxis
Musculoskeletal and connective tissue disorders:
Frequency not known: Arthralgia, arthritis
Infections and infestations
Rare: Genital and anal pruritus, vaginitis
Frequency not known: Vaginal candidiasis
General disorders and administration site conditions
Rare: Tiredness
Frequency not known: Fever
Immune System disorders
Rare: Anaphylactic reaction
Hepatobiliary Disorders
Rare: Hepatitis, cholestatic icterus
Psychiatric Disorders
Frequency not known: Hallucinations, agitation, confusion
4.9
Overdose
Symptoms of oral overdose may include nausea, vomiting, epigastric distress, diarrhoea, and
haematuria.
In the event of severe overdosage, general supportive care is recommended, including close
clinical and laboratory monitoring of haematological, renal, and hepatic functions, and
coagulation status until the patient is stable. Forced diuresis, peritoneal dialysis,
haemodialysis, or charcoal haemoperfusion have not been established as beneficial for an
overdose of cefalexin. It would be extremely unlikely that one of these procedures would be
indicated.
Unless 5 to 10 times the normal total daily dose has been ingested, gastro-intestinal
decontamination should not be necessary.
There have been reports of haematuria, without impairment of renal function, in children
accidentally ingesting more than 3.5g of cefalexin in a day. Treatment has been supportive
(fluids) and no sequelae have been reported.
5
PHARMACOLOGICAL PROPERTIES
5.1
Pharmacodynamic properties
Pharmacotherapeutic group: First generation cephalosporin
ATC code: J01DB01
Mode of Action
Cefalexin is an antibacterial agent of the cephalosporin class. Like other cephalosporins
cefalexin exerts antibacterial activity by binding to and inhibiting the action of penicillinbinding proteins involved in the synthesis of bacterial cell walls. This leads to bacterial cell
lysis and cell death.
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Mechanisms of resistance
Bacterial resistance to cefalexin may be due to one or more of the following mechanisms:
•
•
•
•
Hydrolysis by extended-spectrum beta-lactamases and/or by chromosomally-encoded
(AmpC) enzymes that may be induced or de-repressed in certain aerobic gramnegative bacterial species.
Reduced affinity of pencillin-binding proteins.
Reduced permeability of the outer membrane of certain gram-negative organisms
restricting access to penicillin-binding proteins
Drug efflux pumps
More than one of these mechanisms of resistance may co-exist in a single bacterial cell.
Depending on the mechanism(s) present, bacteria may express cross-resistance to several or all
other beta-lactams and/ or antibacterial medicinal products of other classes.
Breakpoints
Minimum inhibitory concentration (MIC) breakpoints established by the British Society of
Antimicrobial Chemotherapy for beta-haemolytic Streptococci and Streptococcus pneumoniae
are: susceptible ≤ 2mg /l, resistant ≥2.5mg/l.
Susceptibility
The prevalence of resistance may vary geographically and over time for selected species and
local information on resistance is desirable, particularly when treating severe infections. As
necessary, expert advice should be sought when the local prevalence of resistance is such that
the utility of the agent in at least some types of infections is questionable.
Commonly susceptible species
Aerobes, Gram positive:
Staphylococcus aureus (methicillin susceptible)
Streptococcus agalactiae
Streptococcus pneumoniae
Streptococcus pyogenes
Aerobes, Gram negative:
Escherichia coli
Moraxella catarrhalis
Anaerobes:
Peptostreptococcus species
Species for which acquired resistance may be a problem
Gram-negative aerobes:
Citrobacter species
Enterobacter species
Morganella morganii.
Inherently resistant species
Gram-negative aerobes:
Haemophilus influenzae
5.2
Pharmacokinetic properties
Cefalexin is acid stable and may be given without regard to meals. It is rapidly absorbed after
oral administration. Following doses of 250mg, 500mg, and 1g, average peak serum levels of
approximately 9, 18, and 32mg/l, respectively, were obtained at 1 hour. Measurable levels
were present 6 hours after administration. Cefalexin is excreted in the urine by glomerular
filtration and tubular secretion. Studies showed that over 90% of the medicinal product was
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excreted unchanged in the urine within 8 hours. During this period, peak urine concentrations
following the 250mg, 500mg, and 1g doses were approximately 1,000, 2,200, and 5,000mg/l,
respectively.
Cefalexin is almost completely absorbed from the gastro-intestinal tract, and 75-100% is
rapidly excreted in active form in the urine. Absorption is slightly reduced if the drug is
administered with food. The half-life is approximately 60 minutes in patients with normal
renal function. Haemodialysis and peritoneal dialysis will remove cefalexin from the blood.
Peak blood levels are achieved one hour after administration, and therapeutic levels are
maintained for 6-8 hours. Approximately 80% of the active drug is excreted in the urine
within 6 hours. No accumulation is seen with dosages above the therapeutic maximum of
4g/day.
The half-life may be increased in neonates due to their renal immaturity, but there is no
accumulation when given at up to 50mg/kg/day.
5.3
Preclinical safety data
The daily oral administration of cefalexin to rats in doses of 250 or 500mg/kg prior to and
during pregnancy, or to rats and mice during the period of organogenesis only, had no adverse
effect on fertility, foetal viability, foetal weight, or litter size.
Cefalexin showed no enhanced toxicity in weanling and newborn rats as compared with adult
animals.
The oral LD50 of cefalexin in rats is 5,000mg/kg.
6
PHARMACEUTICAL PARTICULARS
6.1
List of excipients
Core:
Microcrystalline cellulose
Magnesium stearate
Water
Capsule shell:
Gelatin
Sodium lauryl sulphate
Sunset yellow FCF (E110)
Quinoline yellow (E104)
Titanium dioxide (E171)
Patent Blue V (E131)
and
Printing ink
Black Ink (SW – 9008) components:
Shellac
Propylene Glycol
Potassium Hydroxide
Black Iron Oxide (E172)
6.2
Incompatibilities
Not applicable
6.3
Shelf life
24 months
6.4
Special precautions for storage
Store below 30°C. Store in the original package.
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UKPAR Cefalexin 250 and 500 mg Capsules
6.5
PL 35507/0104-5
Nature and contents of container
Cefalexin 250 mg Capsules are packed in:
PVC/PVdC/Aluminium blisters of 4, 10, 12, 16, 20, 21, 24, 28, 30, 100 and 112 capsules.
Not all pack sizes may be marketed.
Cefalexin 500 mg Capsules are packed in:
PVC/PVdC/Aluminium blisters of 8, 10, 12, 14, 15, 16, 20, 21, 28, 30, 40, and 100 capsules.
Not all pack sizes may be marketed.
6.6
Special precautions for disposal
No special requirements
7
MARKETING AUTHORISATION HOLDER
Lupin (Europe) Limited,
Victoria Court,
Bexton Road,
Knutsford,
Cheshire WA16 OPF
United Kingdom
8
MARKETING AUTHORISATION NUMBER(S)
PL 35507/0104
PL 35507/0105
9
DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
15/07/2011
10
DATE OF REVISION OF THE TEXT
07/09/2011
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PATIENT INFORMATION LEAFLET
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UKPAR Cefalexin 250 and 500 mg Capsules
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LABELLING
Cefalexin 250 mg Capsules
Carton for blisters, with braille
Braille translation
25
UKPAR Cefalexin 250 and 500 mg Capsules
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Blister foil
26
UKPAR Cefalexin 250 and 500 mg Capsules
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Cefalexin 500 mg Capsules
Carton for blisters, with braille
Braille translation
27
UKPAR Cefalexin 250 and 500 mg Capsules
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Blister foil
28